Medical Oncology

, Volume 29, Issue 2, pp 1005–1009 | Cite as

A decline in weight and attrition of muscle in colorectal cancer patients receiving chemotherapy with bevacizumab

  • Timothy Poterucha
  • Brian Burnette
  • Aminah JatoiEmail author
Short Communication


Weight loss and muscle wasting are of critical importance to cancer patients because of their negative effects on survival, functional status, and tolerability of chemotherapy. Because previous data suggest vascular endothelial growth factor receptor inhibitors disrupt skeletal muscle pathways, such as PI3K and AKT, the current study explored weight loss and muscle wasting in colorectal cancer patients treated with bevacizumab. Patients were assessed for serial weight and radiographic changes in skeletal muscle at baseline and again within 3 months of starting cancer therapy. Computed tomography scans were used to assess muscle. Fifty-seven patients are the focus on this report. These patients manifested a decline in mean weight from 85 to 83 kilograms (P = 0.002). Mean skeletal muscle area at the L3 vertebral level dropped from 148 cm2 to 145 cm2 (P = 0.02). This drop in weight and skeletal muscle occurred independently of cancer progression. No statistically significant differences in survival were observed based on loss of weight or skeletal muscle. Colorectal cancer patients prescribed bevacizumab appear to lose weight and muscle over a few months even in the absence of cancer progression.


Wasting Skeletal muscle Cancer Bevacizumab 



This work was funded by 5K24CA131099.


  1. 1.
    Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629–35.PubMedCrossRefGoogle Scholar
  2. 2.
    Prado CM, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007;13(11):3264–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Demark-Wahnefried W, et al. Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol. 2001;19(9):2381–9.PubMedGoogle Scholar
  4. 4.
    Camoriano JK, et al. Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. J Clin Oncol. 1990;8(8):1327–34.PubMedGoogle Scholar
  5. 5.
    Francini G, et al. Exemestane after tamoxifen as adjuvant hormonal therapy in postmenopausal women with breast cancer: effects on body composition and lipids. Br J Cancer. 2006;95(2):153–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Freedman RJ, et al. Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. J Clin Endocrinol Metab. 2004;89(5):2248–53.PubMedCrossRefGoogle Scholar
  7. 7.
    Steyn RS, et al. Weight gain as an indicator of response to chemotherapy for oesophageal carcinoma. Clin Oncol (R Coll Radiol). 1995;7(6):382–4.CrossRefGoogle Scholar
  8. 8.
    Antoun S, et al. Association of skeletal muscle wasting with treatment with sorafenib in patients with advanced renal cell carcinoma: results from a placebo-controlled study. J Clin Oncol. 2010;28(6):1054–60.PubMedCrossRefGoogle Scholar
  9. 9.
    National-Cancer-Institute. Bevacizumab: first-line treatment of metastatic colorectal cancer. 2009 (cited 8/20/2010); Available from:
  10. 10.
    Lynch T Jr, Kim E. Optimizing chemotherapy and targeted agent combinations in NSCLC. Lung Cancer. 2005;50(S2):S25–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Moen MD. Bevacizumab: in previously treated glioblastoma. Drugs. 2010;70(2):181–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Escudier B, Cosaert J, Pisa P. Bevacizumab: direct anti-VEGF therapy in renal cell carcinoma. Expert Rev Anticancer Ther. 2008;8(10):1545–57.PubMedCrossRefGoogle Scholar
  13. 13.
    Micha JP, et al. A phase II study of outpatient first-line paclitaxel, carboplatin, and bevacizumab for advanced-stage epithelial ovarian, peritoneal, and fallopian tube cancer. Int J Gynecol Cancer. 2007;17(4):771–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Tripathy D. Capecitabine in combination with novel targeted agents in the management of metastatic breast cancer: underlying rationale and results of clinical trials. Oncologist. 2007;12(4):375–89.PubMedCrossRefGoogle Scholar
  15. 15.
    Tsavachidou-Fenner D, et al. Gene and protein expression markers of response to combined antiangiogenic and epidermal growth factor targeted therapy in renal cell carcinoma. Ann Oncol. 2009;21(8):1599–606.CrossRefGoogle Scholar
  16. 16.
    Hurwitz H, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350(23):2335–42.PubMedCrossRefGoogle Scholar
  17. 17.
    Lemieux S, et al. Comparison of two techniques for measurement of visceral adipose tissue cross-sectional areas by computed tomography. Am J Hum Biol. 1999;11(1):61–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Mitsiopoulos N, et al. Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol. 1998;85(1):115–22.PubMedGoogle Scholar
  19. 19.
    Abramoff MD, Magelhaes PJ, Ram SJ. Image Processing with ImageJ. Biophoton Int. 2004;11(7):36–42.Google Scholar
  20. 20.
    Irving BA, et al. NIH ImageJ and Slice-O-Matic computed tomography imaging software to quantify soft tissue. Obesity. 2007;15(2):370–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Prado CM, Birdsell LA, Baracos VE. The emerging role of computerized tomography in assessing cancer cachexia. Curr Opin Support Palliat Care. 2009;3(4):269–75.PubMedCrossRefGoogle Scholar
  22. 22.
    Tol J, et al. Chemotherapy, bevacizumab, and cetuximab in metastatic colorectal cancer. N Engl J Med. 2009;360(6):563–72.PubMedCrossRefGoogle Scholar
  23. 23.
    Sadler IJ, et al. Preliminary evaluation of a clinical syndrome approach to assessing cancer-related fatigue. J Pain Symptom Manage. 2002;23(5):406–16.PubMedCrossRefGoogle Scholar
  24. 24.
    Miller K, et al. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med. 2007;357(26):2666–76.PubMedCrossRefGoogle Scholar
  25. 25.
    Yang JC, et al. A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med. 2003;349(5):427–34.PubMedCrossRefGoogle Scholar
  26. 26.
    Allegra CJ, et al. Initial safety report of NSABP C-08: A randomized phase III study of modified FOLFOX6 with or without bevacizumab for the adjuvant treatment of patients with stage II or III colon cancer. J Clin Oncol. 2009;27(20):3385–90.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Timothy Poterucha
    • 1
  • Brian Burnette
    • 2
  • Aminah Jatoi
    • 2
    • 3
    Email author
  1. 1.Mayo Medical SchoolMayo ClinicRochesterUSA
  2. 2.Department of OncologyMayo ClinicRochesterUSA
  3. 3.RochesterUSA

Personalised recommendations